(Meta Analysis Of Curative Effects Of Laparoscopic Surgery And Microsurgery Treatment Of Adult Male Varicocele)

OBJECTIVE:Systematic evaluation of therapeutic effect of laparoscopic and microsurgical treatment of varicocele, to provide a scientific basis for clinicians to select a safe and effective operation.Methods:Using electronic and manual search method, the first related literature were the initial inspection, electronic retrieval database (Pubmed/Medline database(1995.1-2012.10)、OVID(1995.1-2012.10)、 EMBASE(1995.1-2012.10)、Chinese Biomedical Database(CBM,1995.1-2012.10)、China Academic Journal (CNKI:1995.1-2012.10) Chinese Evidence-Based Medicine/Cochrane Center database(CEBM\CCD)、Cochrane Library; A manual search of the newly published relevant journals, and by all the mainstream search engines to find and study of relevant literature. To collect the relevant research literature on all the operation in the treatment of varicocele, and randomized controlled trials (RCTs). Preliminary screening of all strict literature, the selected document access to full text, and to evaluate the results by Cochrane collaboration bias risk assessment tool. Literature data by two researchers independently extracted, analyzed by Meta RevMan5.1software.RESULTSR:Through the primaries and excluded, eventually5RCTs in accordance with the inclusion criteria involving a total of554cases. Meta analysis results are shown:(1)There are three tests in the five study to extract sperm concentration increased by laparoscope and surgical treatment of varicocele after operation,through the RevMan5.1statistical analysis software with data obtained WMD=4.28,95%CI=(4.16,6.99), P<0.00001, Z=7.72, think of laparoscopic operation in the treatment of varicocele than the open operation short in operation time.(2)There are three tests in the five study to extract the varicocele hospitalized time treated by laparoscopic surgery and microsurgery,through the RevMan5.1statistical analysis software with data obtained WMD=0.24,95%CI=(0.44,0.93),P=0.49,Z=0.69, that there was no statistically significant difference in hospitalization time of two groups.(3)There are three tests in the five study to extract relevant data operation time of varicocele by laparoscopy and microsurgical treatment,through the RevMan5.1statistical analysis software with data obtained,WMD=40.31,95%CI=(37.77,42.86), P<0.00001, Z=31.03, think of laparoscopic operation in the treatment of varicocele than microsurgical operation short in operation time.(4)There are three tests in the five study to extract relevant data rate of hydrocele occurs through laparoscope and surgical treatment of varicocele,through the RevMan5.1statistical analysis software with data obtained WMD=0.05,95%CI=(0.01,0.27), P=0.0005, Z=3.49, think of microsurgical treatment of varicocele postoperative hydrocele rate less than laparoscopic.(5)There are three tests in the five study to extract the recurrence rate of varicocele postoperative related data by laparoscopy and microsurgical treatment,through the RevMan5.1statistical analysis software with data obtained WMD=0.10,95%CI=(0.04,0.25),P<0.00001, Z=5.01, that microscope in the treatment of varicocele recurrence rate less than laparoscopic treatment.Conclusion:The above results show that:two kinds of operation method of microsurgery and laparoscopy in the treatment of varicocele on postoperative sperm concentration and length of hospital stay did not differ significantly. While in the hydrocele of tunica vaginalis and the incidence of postoperative recurrence rate of two indicators of microsurgical than laparoscopic operation.In the indexes of laparoscopic operation time is shorter than the microsurgery.But due to the possible presence of publication bias, selection bias, we look forward to the emergence of more high quality for the above conclusions provide more reliable evidence.